{*} propranolol

reduces risk of bronchospasm

metoprolol

short-acting, used in
surgery or emergency

{*} quinidine

Drugs

esmolol

Drugs

cinchonism
lupus-like syndrome

procainamide

hypotension

beta-adrenergic receptor antagonist

disopyramide

decrease Phase 4 depolarization

(decrease automaticity)
prolong AV conduction

Mechanism

inhibit intermediate Na+ channels

decrease heart rate

slows Phase 0 depolarization rate

Mechanism

decrease contractility

no eect on Phase 3

increase PR interval

Widen QRS interval

atrial flutter/fibrillation

AV block

tachyarrhythmia caused by
increased sympathetic activity

Class II (Beta-Adrenoceptor Inhibitors)

Therapeutic Use

Class IA

AV-node reentrant tachycardia

atrial arrhythmia

Therapeutic Use

ventricular tachyarrhythmia

Class I (Na+ Channel Inhibitors)

paroxysmal supraventricular tachycardia

proarrhythmic eects (class III activity)

hypotension

contraindication: reduced left ventricular function

left ventricular failure

contraindication: ischemic heart disease

AV block

torsade de pointes

bronchospasm

SA and AV block

Adverse Eects

masks signs of hypoglycemia

asystole

Adverse Eects

precipate angina
attack if abruptly
stopped

gastrointestinal eects:
nausea
vomiting
diarrhea

CNS disturbances:
depression
sleep alterations
sedation
heart > vascular smooth muscle

anticholinergic eects

voltage-gated Na+ channel antagonist

(use-dependent: bind to open, inactivated channels)

CNS eects
Class IB
Class IC

verapamil

heart ~ vascular smooth muscle

Drugs

diltiazem

liver metabolism

ibutilide

Adverse Eects

voltage-gated L-type Ca2+ channel

antagonist (use-dependent: bind to
open, depolarized channels)
sotalol

decrease inward Ca2+ current

decrease Phase 4 spontaneous depolarization

torsades de pointe
torsades de pointe

Adverse Eects

excessive beta block

renal elimination
Mechanism

new arrhythmias

decrease conduction velocity

prolong refractory

Adverse Eects

bretyilum

hypotension
renal elimination

ARRHYTHMIA

decrease automaticity

no longer ACLS approved

negative inotrope

favorable kinetics

stop paroxysmal supraventricular tachycardia

Class IV (Ca2+ Channel Inhibitors)

control atrial fibrillation/flutter

fewer drug interactions

dronedarone

reentrant supraventricular tachycardia

proarrhythmia eects > amiodarone

Therapeutic Use

non-emergency use

Drugs
(mnemonic: k is bad)

coronary vasodilation
increase PR interval

gastrointestinal discomfort
hypotension

hypotension
verapamil

pulmonary fibrosis

constipation
bradycardia
AV block

exacerbate heart failure

hepatotoxicity

amiodarone

Adverse Eects

Adverse Eects

corneal microdeposits
skin discoloration (blue-gray)

negative inotrope

contraindication: hepatic dysfunction (verapamil)

hypo/hyperthyroidism

Class III (K+ Channel Inhibitors)

peripheral neuropathy

contraindication: depressed cardiac function

thrombocytopenia (rare)

adenosine receptor activation

increases K+ current

liver metabolism

Mechanism

increase AV node refractory

long half-life

slow automaticity

has class I, II, III, and IV eects

asystole (brief)

adenosine

chest pain

dofetilide

Adverse Eects

K+ channel antagonist

shortness of breath / dyspnea

terminate paroxysmal
supraventricular tachycardia

decrease outward K+ current during

repolarization

Therapeutic Use

Mechanism

patients with unstable

hemodynamics
patients with atrial fibrillation

Therapeutic Use

digoxin

Drugs

Torsade de Pointes

increase QT interval

digixin toxicity

ibutilide
dofetilide
amiodarone

Therapeutic Use

Therapeutic Use

treatment/prevent ventricular
tachycardia/fibrilation
treatment/prevent atrial/ventricular
arrhythmia

Adverse Eects
Class IA

respiratory paralysis

Adverse Eects

see individual drug

Class IB

circulatory collapse

Class IC
propranolol
esmolol

Class II: Beta-Adrenoceptor

Inhibitor

Class II: Beta-Adrenoceptor

Inhibitor
Liver

METABOLISM/EXCRETION

Renal
Class III: K+ Channel Inhibidor

ibutilide
dofetilide

bretylium
sotalol

Magnesium Sulfate (Mg2+)

mild bradycardia
hypotension

treatment/prevent atrial fibrilation/

flutter

Mechanism

hinder K+ replenishment

prolong action potential duration

(Phase 0 unaltered)
prolong eective refractory period

Other

patients with rapid ventricular rate

correct hypomagnesemia

liver metabolism

Class III: K+ Channel Inhibidor

amiodarone
Class IV: Ca2+ Channel Inhibitor

atenolol
bretylium
sotalol

amiodarone